Donor and surgical risk factors for primary graft failure following Descemet's stripping automated endothelial keratoplasty in Asian eyes

Abstract

BackgroundDescemet’s stripping automated endothelial keratoplasty (DSAEK) has been shown to have superior refractive and visual results compared with penetrating keratoplasty, but higher rates of primary graft failure (PGF). This paper presents donor and surgical risk factors for PGF in DSAEK cases in Asian eyes.DesignRetrospective case-control study.ParticipantsAll consecutive patients who underwent DSAEK at a tertiary referral teaching hospital from March 2006–December 2008.MethodsDonor details analyzed were: age of donor, cause of donor death, death to harvesting time, donor storage time, distribution distance of tissue, preoperative endothelial cell count. Surgical factors analyzed were: donor diameter, donor thickness, and method of donor insertion. These risk factors in cases of PGF were compared with patients with successful DSAEK as the control group.Main outcome measurePGF.ResultsA total of 124 DSAEK procedures were performed. Six DSAEK procedures (five eyes of five patients; one eye with two failures) resulted in PGF (4.8%). Significant risk factors were found for PGF to include graft insertion using a folding technique (odds ratio [OR], 34.03; 95% confidence interval [CI], 3.75–314.32; P = 0.0017) and a small donor diameter (OR, 39.94; 95% CI, 2.18–732.17; P = 0.013).ConclusionThe results of this study suggest that in Asian eyes with shallow anterior chambers, surgical trauma relating to the technique of donor insertion, and the use of a small donor are major risk factors for PGF following DSAEK.

Clinical outcome of Descemet stripping automated endothelial keratoplasty in 18 cases with iridocorneal endothelial syndrome

“…The biometrically shallow anterior chamber in Asian eyes 23 results in greater surgical trauma to endothelial cells and the use of relatively little donor tissue, both of which were risk factors for graft failure. 27,28 Immediate postoperative complications may accelerate the manifestation of SGF. Transient high IOP could affect the activity of endothelial cells, which may be exacerbated in the presence of other pathological factors in ICE syndrome and result in poor long-term survival.…”

Long-term outcomes of endothelial keratoplasty in Chinese eyes at a University Hospital

“…Primary graft failure in DSEK can also occur because of primary donor endothelial failure but is more often attributed to excessive endothelial cell trauma during the surgical procedure. A recent retrospective case–control study of Asian patients [ 18 ] who underwent EK analyzed the risk factors in cases of primary graft failure. The rate of primary graft failure was 4.8% in this study.…”

Descemet’s stripping and non-Descemet’s stripping automated endothelial keratoplasty for microcornea using 6.0 mm donor grafts

“…Ang et al advocated use of larger donor grafts because they showed that primary graft failure was less when using a >8.0 mm donor 23. Meanwhile, in a 2-year follow-up study by Terry et al, no difference was found in terms of endothelial cell density between the 8 mm and 8.5 mm grafts in Fuchs dystrophy eyes 20.…”